InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study

• Type of Material: Article
• Authors: Marcos Tadashi Kakitani Toyoshima, Universidade de São Paulo; Pedro Henrique Ribeiro Brandes, Universidade de São Paulo; Gerhard da Paz Lauterbach, Universidade de São Paulo; Jéssica Ribeiro Andrade Moraes, Universidade de São Paulo; Edison Ferreira de Paiva, Universidade de São Paulo; Guillermo E. Umpierrez, Emory University; Marcia Nery, Universidade de São Paulo; Rodrigo Hidd Kondo, Universidade de São Paulo
• Language: English
• Date: 2022-06-27
• Publisher: The Brazilian Society of Endocrinology and Metabolism
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: 2022, The Brazilian Society of Endocrinology and Metabolism
• Final Published Version (URL): https://doi.org/10.20945/2359-3997000000496
• Title of Journal or Parent Work: Archives of Endocrinology and Metabolism
• Volume: 66
• Issue: 4
• Start Page: 498
• End Page: 505
• Grant/Funding Information: None
• Keywords: inpatients; insulin; Type 2 diabetes mellitus; hyperglycemia; hospitalists
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Public Health

Abstract

Objective: We assessed metrics related to inpatient glycemic control using InsulinAPP, an application available for free in Brazil, on the hospitalist-managed ward of our hospital. Subjects and methods: We performed a retrospective study of patients with type 2 diabetes (T2D) admitted from November 2018 to October 2019. InsulinAPP recommends NPH and regular insulins three times a day, in bolus-correction or basal-bolus schemes. Parameters that included BG within range of 70-180 mg/dL, insulin treatment regimen and frequency of hypoglycemia were evaluated. Results: A total of 147 T2D individuals (23% medicine and 77% surgery) were included (mean age 62.3 ± 12.7 years, HbA1c: 8.3 ± 3.0%). The initial insulin regimen was 50% bolus-correction, 47% basal-bolus and 3% with sliding scale insulin. During hospitalization, 71% patients required a bolus-basal regimen. In the first 10 days of the protocol, 71% BG measurements were between 70-180 mg/dL and 26% patients experienced one or more episodes of hypoglycemia < 70 mg/dL, and 5% with BG < 54 mg/dL. Conclusion: The results of this retrospective study indicate the InsulinAPP application using human insulin formulations was effective and safe for the management of hyperglycemia on a hospitalist-managed ward, with more than 70% BG measurements within the therapeutic range and a low rate of hypoglycemia.